Research question

What are the hormonal and ovarian histological effects of a gender affirming hormonal therapy in assigned female at birth (AFAB) transgender people?

Design

Prospective observational study of 70 AFAB transgender people taking testosterone therapy before gender-affirming surgery (hystero-oophorectomy). A gynaecological ultrasonographic scan was undertaken and serum hormone concentrations measured, including anti-Müllerian hormone (AMH) and androgenic profile. Histological ovarian evaluation was assessed in both ovaries, including the developmental stages of the follicles.

Results

The mean age of the population was 27.7+/–5.14 years. The main biochemical parameters were total testosterone levels 781.5 ± 325.9 ng/dl; AMH levels 3.2 ± 1.4 ng/ml; FSH and LH levels 4.9 ± 2.5 IU/l and 3.9 ± 2.9 IU/l, respectively; and oestradiol values 47.6 ± 13.7 pg/ml. Fifty-five AFAB underwent gynaecological ultrasound before surgery and antral follicles were found in 43 out of 47 ultrasounds (91.5%) (without the presence of a dominant follicle or corpus luteum). Histological follicles were mostly in the primordial stage (88.0) and 3.3% were atretic. The thickness of the tunica albuginea was widely heterogeneous (range 0.15–1.45 mm) and luteinization of the stromal cells was observed in 68.6% of the samples. A negative correlation between testosterone levels and total antral follicles was found (R_s= –0.306, P = 0.029).

Conclusions

AFAB transgender people taking testosterone therapy show cortical follicle distribution in the range previously reported in fertile cisgender women of reproductive age. The follicular population may not be altered as a result of the gender-affirming hormonal therapy, although some cortical and stromal changes have been observed.

中文翻译：

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接受睾酮治疗的出生变性女性的内分泌和卵巢组织学调查

研究问题

在指定的出生时女性 (AFAB) 跨性别人群中，性别肯定激素疗法对激素和卵巢组织学的影响是什么？

设计

对 70 名 AFAB 跨性别者在性别确认手术（子宫卵巢切除术）前接受睾酮治疗的前瞻性观察研究。进行妇科超声扫描并测量血清激素浓度，包括抗苗勒管激素 (AMH) 和雄激素谱。在两个卵巢中评估组织学卵巢评估，包括卵泡的发育阶段。

结果

人口的平均年龄为 27.7+/-5.14 岁。主要生化参数为总睾酮水平 781.5 ± 325.9 ng/dl；AMH 水平 3.2 ± 1.4 ng/ml；FSH 和 LH 水平分别为 4.9 ± 2.5 IU/l 和 3.9 ± 2.9 IU/l；和雌二醇值 47.6 ± 13.7 pg/ml。55 名 AFAB 在手术前接受了妇科超声检查，47 次超声检查中有 43 次（91.5%）发现了窦卵泡（不存在优势卵泡或黄体）。组织学卵泡大多处于原始阶段（88.0），3.3% 为闭锁。白膜的厚度很不均匀（范围 0.15-1.45 mm），在 68.6% 的样本中观察到基质细胞的黄体化。发现睾酮水平与总窦卵泡呈负相关（R _s= –0.306，P  = 0.029）。

结论

接受睾酮治疗的 AFAB 变性人显示皮质卵泡分布在先前报道的育龄生育顺性别女性的范围内。尽管已经观察到一些皮质和间质的变化，但确认性别的激素治疗可能不会改变卵泡群体。